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New research from Vancouver, published this month in the Annals of Emergency Medicine, underscores the complexities, costs and harms of managing prescription drugs. Researchers, led by emergency physician Corinne Hohl of Vancouver General Hospital, were looking at the role that adverse drug events play on the patients admitted to the emergency department. After adjusting for differences in baseline characteristics, Dr. Hohl and colleagues found no difference in mortality between patients admitted with medication-related problems and those where meds did not play a part. But what they did find in the 1,000 patients they followed was that when an adverse drug event was involved:

-Patients had a 50% greater likelihood of spending additional days in the hospital

-Patients required 20% more outpatient care.

-The costs of treatment were 90% higher.

Compounding these unfortunate findings: “Nearly 70 percent of these incidents are preventable,” says Dr. Hohl. The researchers are actively working on solutions to address this costly and harmful problem. "We anticipate the development of a screening tool will be able to increase the recognition rate of these adverse drug events from 60 to over 90 percent, and we will be able to treat the patient effectively and rapidly, improving his or her care. The hope is to prevent many of these adverse events from even taking place."

Prevention with mHealth and Personal Health Records

Here’s yet another place where relatively simple patchwork technology solutions might help with prevention efforts, and mhealth and personal health records jump out as high value approaches. Even if a practice doesn’t employ a full-scale personal health record, what about a PHR add-on to electronic prescribing (lets call it an RxPHR)? Here’s how it might work: The doc orders a prescription, and in addition to the printed prescription that the patient will hand over to the pharmacists, a few additional pieces of information are generated. The doc might tell you that you are receiving Medicine X, 5 milligrams a day. But when you get the bottle from the pharmacist, it tells you to take two teaspoonfuls twice a day. Is that the same as what the doctor ordered? Your RxPHR should tell you what the pharmacist’s instructions are likely to be. You should also know what some generic equivalents are, so if the name sounds different, you know whether that’s a problem or not. And of course it should have information about side effects, how to store the meds, whether to take with food, etc… You often receive this in a printout from the pharmacy, but lets face it, have you ever read that material? And its way too easy to loose. So why not be able to access all of this in an electronic, mobile format, perhaps an app. And at the same time, why not have an automatic health reminder feature that you can turn on, so your phone beeps when its time for your dose. Or for “use as needed” prescriptions, a beep at the end of the day asking you to input how many times you used your asthma inhaler, for example. Periodically the system could talk back to the e-prescription system in the doctor’s office, in part to remind the doc that you are still taking that medication (many problems arise from patients taking meds indefinitely instead of ending it at a certain point.)

All of this information could be communicated from the doctors system to your RxPHR. The format would be consistent for every drug you receive so you are familiar with it. The patient could also receive printed copies of information where it seems important, or perhaps could access handy PDFs that they could print in the future.

Especially in the management of medications, its clear that the patient is the focal point of information. They need to be empowered with greater access to usefull information. They are the only ones aware of how/when/ what they are taking. They may see multiple doctors prescribing multiple meds, and all those docs may have electronic medical records (EMR), but unless they are all part of a highly wired system such as Kaiser Permanente, it is unlikely that they are all working from the same EMR, and aware of who is prescribing what. Empowering the patient with relatively simple mhealth or limited personal health records seems like one potential solution, especially with the ubiquity of smart phones.

Are you aware of such a system that already exists? I’d love to learn more about it.